title: Poor agreement among expert witnesses in bile duct injury malpractice litigation: an expert panel survey.
abstract: OBJECTIVE
  To determine the inter-rater agreement of expert witness testimonies in bile duct injury malpractice litigation.
  
  
  BACKGROUND
  Malpractice litigation is an increasing concern in modern surgical practice. As most of the lawyers are not educated in medicine, expert witnesses are asked to testify about negligence of care in most jurisdictions. Although expert witnesses greatly determine the outcome of a claim, the reliability of expert testimony may be arbitrary.
  
  
  METHODS
  Surgical expert witnesses independently assessed whether negligence of care occurred by reviewing the complete medical history of closed litigation cases. All cases concerned iatrogenic bile duct injury, which occurred during laparoscopic cholecystectomy. The level of agreement was measured and case characteristics associated with negligence were determined.
  
  
  RESULTS
  Thirteen independent experts reviewed 10 closed litigation cases. In 1 of the 10 cases, full agreement was observed. In 7 of the 10 cases, the highest percentage of agreeing experts was 53% or less. Chance-corrected levels of agreement were in the slight to fair range (Kendall W coefficient of concordance = 0.16-0.25). Disease-related mortality was associated with judgments on negligence (P = 0.02). Judgments on negligence of care were not associated with delay in diagnosis or the severity of injury. Experts with more years of clinical experience agreed more about negligence. Experts working in an academic setting agreed less than experts working in a teaching hospital. Finally, 8 of the 13 experts plead for the assignment of more than 1 expert witness to review and comment in a surgical litigation case.
  
  
  CONCLUSIONS
  The reliability of expert witness testimonies in bile duct injury litigation is frail. Defendants, plaintiffs, experts, and lawyers should be aware of the drawbacks of expert witness testimonies. Raising consensus concerning the standards of surgical care may be required to improve agreement in judgments on negligence.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Philip R
authors.initials: PR
authors.lastname: de Reuver
authors.forename: Marcel G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: Sjef K M
authors.initials: SK
authors.lastname: Gevers
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000331:legislation & jurisprudence*; D002764:Cholecystitis / Q000601:surgery; D041761:Cholecystolithiasis / Q000601:surgery; D005104:Expert Testimony; D006801:Humans; D007431:Intraoperative Complications; D008318:Malpractice / Q000331:legislation & jurisprudence*; D009426:Netherlands; D015588:Observer Variation; D011379:Prognosis